Recent Advances in Color and Whiteness Evaluations in Dentistry

Development of toothpaste formulations containing mineral clays as abrasive agents and their effects on the physical properties of dental enamel

To assess the physical properties and topographical aspect of dental enamel's surface microhardness (KHN), surface roughness (Ra), and color parameters CIELAB (∆Eab*), CIEDE 2000 (∆E00), and whiteness index for dentistry (∆WID) after toothbrushing with experimental toothpaste formulations with the following mineral clay types: kaolin, Sparclay SGY, and Tersil CGY used as abrasive component. Scanning electron microscopy (SEM) was performed for topographical analyses purposes. A total of 96 bovine incisors were used in the experiment. They were divided into eight experimental groups (n = 12), namely: NC-negative control (no treatment), CT12-Colgate Total 12®, CMP-Colgate® Máxima Proteção Anticáries, K-kaolin experimental toothpaste, SGY-Sparclay SGY experimental toothpaste; CGY-Tersil CGY experimental toothpaste, SD-SiO2 experimental toothpaste, and CC-CaCO3 experimental toothpaste. All samples were subjected to mechanical brushing protocol with 5000 cycles and kept in artificial saliva with daily exchanges. KHN was analyzed through the mixed linear model for repeated measures over time. Ra was analyzed through nonparametric Kruskal Wallis and Dunn tests to compare the groups. Paired Wilcoxon test was run to compare experimental times. ∆WID, ∆Eab*, and ∆E00 were analyzed through Kruskal Wallis and Dunn tests. All analyses were performed in R* software, at 5% significance level. EXP_SGY recorded higher KHN than EXP_SiO2 and EXP_CaCO3, whereas EXP_K showed increased Ra in comparison to CMP (p = 0.0229). ∆Eab and ∆E00 were significantly higher in the CT12, EXP_SiO2, and EXP_CaCO3 groups than in the NC and EXP_K (p < 0.0001). There were no significant changes in ∆WID (p = 0.0852). According to SEM results, toothbrushing with experimental toothpastes added with mineral clay types did not have significant impact on enamel's polishing and smoothness. CLINICAL RELEVANCE: Mineral clays have a broad application in the cosmetic industry, and recently, they have been used in the formulation of vegan toothpaste.

Chiral Pearlescent Cellulose Nanocrystals Films with Broad-Range Tunable Optical Properties for Anti-Counterfeiting Applications

Pearlescent materials are of technological importance in a diverse array of industries from cosmetics to premium paints; however, chiral pearlescent materials remain unexplored. Here, chiral pearlescent films with on-demand iridescence and metallic appearance are simply organized by leveraging vertical pressure to direct the self-assembly of cellulose nanocrystals. The films are formed with a bilayer planar anchored left-handed chiral nematic architecture, in which the bottom layer is featured with a vertical gradient pitch, and the top layer is featured with a uniform pitch. Simultaneous reflection of the rainbow colors and an on-demand color of left-handed polarized light with angle-dependent wavelength and polarization state accounts for the unique optical phenomenon based on experimental observation and theoretical analysis. Such chiroptical property can be readily tuned with architectural design, enabling reproducible optical appearance with high fidelity. Bringing the pearlescence, iridescence, and specular reflection together endows cellulose nanocrystal films with rich and tunable chiroptical properties that can be used for anti-counterfeiting applications. The current work marks the beginning of chiral pearlescent materials from renewable resources, while the pressure-directed self-assembly provides a step toward scalable production.

Effects of Sitting and Supine Positions on Tongue Color as Measured by Tongue Image Analyzing System and Its Relation to Biometric Information

Tongue diagnosis is one of the important diagnostic methods in Kampo (traditional Japanese) medicine, in which the color and shape of the tongue are used to determine the patient's constitution and systemic symptoms. Tongue diagnosis is performed with the patient in the sitting or supine positions; however, the differences in tongue color in these two different positions have not been analyzed. We developed tongue image analyzing system (TIAS), which can quantify tongue color by capturing tongue images in the sitting and supine positions. We analyzed the effects on tongue color in two different body positions. Tongue color was quantified as L∗a∗b∗ from tongue images of 18 patients in two different body positions by taking images with TIAS. The CIEDE 2000 color difference equation (ΔE00) was used to assess the difference in tongue color in two different body positions. Correlations were also determined between ΔE00, physical characteristics, and laboratory test values. The mean and median ΔE00 for 18 patients were 2.85 and 2.34, respectively. Of these patients, 77.8% had a ΔE00 < 4.1. A weak positive correlation was obtained between ΔE00 and systolic blood pressure and fasting plasma glucose. Approximately 80% of patients' tongue color did not change between the sitting and supine positions. This indicates that the diagnostic results of tongue color are trustworthy even if medical professionals perform tongue diagnosis in two different body positions.

Influence of Thickness on the Translucency Parameter and Whiteness Index of Single-Shade Resin Composites

The study aimed to evaluate the effect of thickness on the translucency parameter (TP) and whiteness index for dentistry (WID) of single-shade resin composites compared with a multi-shade resin composite after thermocycling. A total of 100 resin composite samples of five brands (Filtek Z250, Omnichroma, Vittra APS Unique, Zenchroma, and Charisma Diamond One) with thicknesses of 2 mm and 4 mm were prepared (n=10). CIE L*a*b* coordinates were obtained using a spectrophotometer. The resin composite samples were subjected to 10,000 thermocycles. Before and after thermocycling, TP values were calculated with the CIEDE2000 formula, and whiteness values were calculated using the WID. The influence of thickness, resin composite, and aging on these variables was analyzed using the generalized linear model (p<0.05). Omnichroma and Filtek Z250 exhibited, respectively, the highest and the lowest TP00 values compared with the other resin materials (p<0.001). The TP00 values of Zenchroma and Diamond One were similar (p>0.05). Vittra APS Unique had a lower TP than Zenchroma and Diamond One (p<0.001). Before thermocycling, the highest WID showed the combination of Vittra APS Unique with thicknesses of 2 mm (48.33±1.18). After thermocycling, the highest WID was shown in the combination of Vittra APS Unique with thicknesses of 2 mm (45.33±0.55) and 4 mm (46.23±0.94) (p<0.001). After thermocycling, the lowest WID was for the combination of Filtek Z250 with thicknesses 2 mm (21.16±0.93) and 4 mm (20.70±0.91) (p<0.001). The TP and WID values of the resin composites varied across different composites and thicknesses. Single-shade resin composites of different thicknesses demonstrated higher translucency and whiteness values than multi-shade resin composite, both before and after thermocycling.

Effect of topical application of ibuprofen/arginine on the in-office bleaching-induced tooth sensitivity: A randomized, triple-blind controlled trial

OBJECTIVE

The application of anti-inflammatories as topical desensitizers before dental bleaching is an approach to reduce bleaching-induced tooth sensitivity (TS). This randomized controlled trial compared the risk and intensity of TS and the color change resulting from in-office dental bleaching after using an experimental desensitizing gel containing ibuprofen and arginine.

METHODS

Sixty-two participants with upper canine shades A2 or darker were randomly assigned to either the ibuprofen-arginine desensitizing group or the placebo group. The desensitizing gel was applied for 15 min before in-office bleaching with 35 % hydrogen peroxide gel for 50 min (2 sessions). To assess the absolute risk and intensity of TS, visual (0-10) and numeric rating (0-5) scales were used, and group comparisons were made using the McNemar test, Wilcoxon test, and paired Student t-test (α = 0.05). Color change was evaluated using Vita Classical, Vita Bleachedguide (ΔSGU), and Vita EasyShade (ΔEab, ΔE00, and ΔWID) before and one month after the bleaching procedure. Group comparisons for color change were done using a paired t-test (α = 0.05).

RESULTS

The odds ratio for TS was 0.14 [95 % CI 0.02 to 0.6], meaning lower odds of TS for the desensitizing gel. A lower intensity of TS was also observed for the experimental group (p < 0.005) up to 48 h after bleaching. All color evaluation tools demonstrated effective and similar whitening for both groups (p > 0.05).

CONCLUSIONS

Using the experimental desensitizing gel containing ibuprofen and arginine effectively reduced the risk and intensity of TS without compromising the bleaching efficacy.

CLINICAL RELEVANCE

The topical application of ibuprofen/arginine on the in-office bleaching reduced risk and intensity of bleaching-induced tooth sensitivity.

Color match of single-shade restorations after professional dental bleaching: An in vitro study

Background

Restorative dentistry aims to reproduce natural tooth shades through resin composites that must be layered to obtain colors, opacities, and translucencies, and therefore, clinical success is operator skill dependent.

Aims

The purpose of this study is to evaluate the color shift of single-shade composite restorations before and after dental bleaching.

Materials and Methods

Eighty human extracted posterior teeth were restored with four single-shade composites (Omnichroma OM; Clearfil Majesty ES-2 Universal CL; Essentia Universal ES; Venus Diamond One VE) (n = 20 each). Standardized V class cavities were prepared on buccal side. VITA Easyshade V spectrophotometer was used to register VITA color and color coordinates 24 h before (T0), 24 h after (T1), and 1 week after (T2) dental bleaching (Opalescence Boost PF 40%). Color differences (ΔEab) and (ΔWID) were calculated and subjected to statistical analysis.

Statistical Analysis

Categorical variables were analyzed using Pearson Chi-square, and data from color coordinates were analyzed using one-way analysis of variance and Tukey's multiple comparison test with Bonferroni correction. Paired t-tests were performed to compare continuous measures between groups and treatment time.

Results

Instrumental evaluations revealed statistically significant differences between materials (P < 0.05) with lower values for ES and VE samples followed by CL and OM at T0 and T1. At T2, OM and CL ΔEab values decrease getting closer to ES and VE.

Conclusion

Single-shade composites seem to match with the surrounding bleached tooth.

Color reproduction trueness of 3D-printed full-color dental casts with scans derived from an intraoral scanner

PURPOSE

To investigate the effects of shade tab color variations (tooth-colored vs. gingiva-colored) and surface treatment (application of mineral oil) on the trueness of color reproduction from dental shade tabs to 3D-printed full-color dental casts, using digital scans obtained from an intraoral scanner.

MATERIALS AND METHODS

Pristine tooth-colored (with 16 shade tabs) and gingiva-colored (with five shade tabs) shade guides were digitally scanned using an intraoral scanner, and subsequently, 3D-printed replicas were created using a full-color material jetting 3D printer. Three color measurements using a contact type digital spectrophotometer were recorded, including actual shade tabs (R0), dried 3D-printed study samples (RP1 ), and study samples with mineral oil application (RP2 ), in this study to calculate color differences between the actual shade tabs and 3D-printed ones. The CIEDE2000 formula was used to calculate the color differences (color reproduction trueness) between reference shade tabs and 3D-printed full-color study samples-without and with mineral oil, ∆E00 (RP1 ), and ∆E00 (RP2 ). ∆E00 (RP1 ) and ∆E00 (RP2 ) were compared with a 50:50% accessibility threshold (AT) and a 50:50% perceptibility threshold (PT). A grading system, based on the relative ranges of AT and PT, was employed. The percentage of samples falling into each color-matching category was then recorded. The data collected were subjected to statistical analysis, utilizing a mixed model ANOVA to evaluate the effects of shade tab color and mineral oil application on color differences, α = 0.05.

RESULTS

The application of mineral oil significantly affected the ∆E00 [F(1, 378) = 19.1, p = < 0.0001]. However, this effect was only significant for the gingiva-colored study samples; the mineral oil application significantly decreased color difference, showing ∆E00 (RP1 ) of 8.71 ± 3.78 and ∆E00 (RP2 ) of 6.55 ± 2.14 (p < 0.0001). For the tooth-colored groups, the mineral oil application did not yield any color difference, showing ∆E00 (RP1 ) of 7.05 ± 2.35 and ∆E00 (RP2 ) of 6.94 ± 2.35 (p = 0.497). In the absence of mineral oil, gingiva-colored samples revealed a significantly larger ∆E00 (RP1 ) of 8.71 ± 3.78 compared to tooth-colored samples at 7.05 ± 2.35 (p = 0.017). Conversely, mineral oil application rendered comparable ∆E00 (RP2 ) values between gingiva-colored (6.55 ± 2.14) and tooth-colored (6.94 ± 2.35) samples (p = 0.558). All 3D-printed full-color samples showed Grade 1 (extremely unacceptable mismatch) and Grade 2 (clearly unacceptable mismatch), regardless of the shades or the presence of mineral oil.

CONCLUSIONS

Utilizing an intraoral scanner to gather digital color data, along with an MJ 3D printer, offers the potential for producing 3D-printed full-color dental casts for prosthesis characterization in the dental laboratory. While mineral oil improves the color reproduction trueness of gingiva-colored objects, all 3D-printed full-color samples exhibited unacceptable mismatches when compared to their target objects. This underscores the need for future improvement in the digital color data acquisition process and color optimization protocols in 3D printing processes.

In vitro bleaching efficacy of violet LED associated with 10% hydrogen peroxide and 10% carbamide peroxide

BACKGROUND

This in vitro study evaluated the efficacy and the effect over the dental enamel surface of violet LED dental bleaching associated to different concentrations of carbamide and hydrogen peroxide.

METHODS

Human dental blocks (n = 100) were randomly distributed into 5 groups: 10% hydrogen peroxide (HP10), 10% carbamide peroxide (CP10), 10% hydrogen peroxide with violet LED (VHP10), 10% carbamide peroxide with violet LED (VCP10) and 35% hydrogen peroxide (HP35). The specimens were analyzed by Vickers microhardness test (n = 50) initially, immediately after and seven days after ending the bleaching protocol. For color analysis (n = 50), the specimens were evaluated for bleaching effectiveness (ΔE2000, ΔE1976) and whiteness index (ΔWID) with EasyShade spectrophotometer, before bleaching protocol and seven days after ending the bleaching protocol. The microhardness and color data were analyzed using one-way ANOVA with post-hoc Tukey test (α = 0.05).

RESULTS

The microhardness values showed difference among the investigated groups only immediately after the end of the dental bleaching (p < 0.05), with reduction for the groups HP35 (p < 0.01) and HP10 (p < 0.05), however the microhardness values were reestablished after seven days. Regarding the color changes, a difference between VHP10 and the others groups evaluated for ΔE2000 and ΔE1976 index was observed (p < 0.05). For ΔWID, there was no difference between the studied groups.

CONCLUSIONS

Violet LED associated with low concentration bleaching agents did not show a negative effect on dental enamel regarding the surface microhardness. All bleaching protocols were effective, therefore, perceptible to human eyes.

Do different adhesives influence the color stability and fluorescence of composite restorations after aging?

This study aimed to evaluate the influence of dental adhesive color on the chromatic stability and fluorescence intensity of composite resin restorations of different thicknesses. Ninety bovine enamel samples were obtained and restored with resin composite varying thicknesses of restorative material and enamel (1.0 mm enamel and 1.0 mm composite; 1.5 mm enamel and 0.5 mm composite; 0.5 mm enamel and 1.5 mm composite). The restorations were made of composite resin (Opallis E-bleach H) using different types of dental adhesives: Ambar, Ambar APS, and Single Bond Universal (n=10). The samples were subjected to color measurement tests in a spectrophotometer using CIEDE2000 and fluorescence intensity measurements before and after aging in a red wine coloring solution. Data were subjected to analysis of variance (ANOVA) and Tukey's test (α = 0.05). There were no statistically significant changes in color stability or fluorescence intensity for restorations made of different materials or thicknesses (p>0.05). Single Bond Universal showed greater color stability at 0.5 mm thickness (ΔE00 = 4.4 ± 1.6) compared to other thicknesses of the same material (p=0.003), as well as a greater difference in fluorescence intensity after aging at 1.5 mm thickness (-414.9 ± 103.8) compared to other materials (p=0.0002). Overall, it was concluded that the different adhesive systems did not influence the color stability and fluorescence of restorations of different thicknesses.

The influence of smoking on the effectiveness of at-home bleaching: A prospective clinical study

OBJECTIVES

To evaluate the effect of smoking on tooth whitening and color change after at-home bleaching.

MATERIALS AND METHODS

This prospective clinical study evaluated two groups of participants: NS-non-smokers (n = 24) and S-smokers (n = 16). All subjects were treated with at-home bleaching using 22% carbamide peroxide (CP) for 1 h/day for 14 days. Color coordinates (L*-luminosity, a*-red-green axis and b*-yellow-blue axis) were obtained before bleaching (D0-baseline), 1 day (D1), 15 days (D15), and 1 month (D30) after bleaching. The whiteness index (WID ) and CIEDE2000 color differences (ΔE00 ) were calculated for S and NS. Color changes between S and NS subjects for specific teeth (CI-Central Incisors, LI-Lateral Incisors, and C-Canines) were analyzed using the Mann-Whitney test (α = 0.05).

RESULTS

There was no significant difference in WID between S and NS subjects at baseline. NS participants showed higher WID than S at D1, D15, and D30 (p < 0.05). NS showed higher ΔWID for CI and C between D0 and the other evaluation times (D1, D15, and D30) compared to S. Smokers showed higher darkening of CI than NS in ΔWID D30-D1 (p < 0.05). Color changes showed similar overall behavior for ΔWID . For all evaluation times, ΔWID and ΔE00 values were below the corresponding acceptability thresholds.

CONCLUSION

At-home bleaching was effective on smokers and nonsmokers. Smoking negatively affected color stability after bleaching. ΔE00 and ΔWID were acceptable for both groups.

CLINICAL SIGNIFICANCE

Although smoking negatively affected color stability after bleaching, the observed changes were clinically acceptable.

Effect of experimental bleaching gels with polymers Natrosol and Aristoflex on the enamel surface properties

Natrosol and Aristoflex® AVC polymers are widely applied in the cosmetic industry and have recently been applied as a thickener option in the composition of dental bleaching gels, with the purpose to reduce the adverse effects on enamel mineral components. The aim of this study was to evaluate the color variation (ΔE* ab, ΔE00, ∆WID), surface roughness (Ra), and mineral content quantification (Raman Spectroscopy) of dental enamel after bleaching treatment with experimental gel-based on 10% carbamide peroxide (CP), containing Carbopol, Natrosol, and Aristoflex® AVC. Sixty bovine teeth were randomly divided into 6 groups (n=10): Negative Control (NC) - no treatment; Positive Control (PC) - Whiteness Perfect 10% - FGM; CP with Carbopol (CPc); CP with Natrosol (CPn); CP with Aristoflex® AVC (CPa); NCP - no thickener. Data were analyzed, and generalized linear models (∆WID -T0 x T1) were used for repeated measurements in time for Ra and with a study factor for ΔE* ab and ΔE00. For the evaluation of the mineral content, data were submitted to one-way ANOVA and Tukey tests. For enamel topographic surface analysis the Scanning Electron Microscope (SEM) was performed. A significance level of 5% was considered. ΔE* ab and ΔE00 were significantly higher for CPc, CPn, CPa, and NCP groups. (∆WID) showed a significantly lower mean than the other groups for NC in T1. After bleaching (4-hour daily application for 14 days), Ra was higher in the CPc, CPn, and PC groups. For CPa, Ra was not altered. No significant difference was found in the quantification of mineral content. CPa preserved the surface smoothness more effectively. Aristoflex® AVC is a viable option for application as a thickener in dental bleaching gels, presenting satisfactory performance, and maintaining the whitening efficacy of the gel, with the advantage of preserving the surface roughness of tooth enamel without significant loss of mineral content.

Development of Thickness-Dependent Predictive Methods for the Estimation of the CIEL*a*b* Color Coordinates of Monolithic and Layered Dental Resin Composites

Usually, dentin and enamel shades are layered in dental restorations with the purpose of mimicking the natural appearance of teeth. The main objective of this study was to develop and assess accuracy of a color-prediction method for both monolithic and layered dental resin-based composites with varying shades and under different illuminants. A total of 15 different shades of VITAPAN Excell, VITAPAN Dentine and VITA Physiodens as well as VITA Enamel of five different thicknesses (0.5-2.5 mm range) were used to manufacture monolithic and layered samples. A non-contact spectroradiometer with CIE 45∘/0∘ geometry was used to measure the color of all samples over a standard ceramic black background. Second-degree polynomial regression was used as predictive method for CIE-L*a*b* color coordinates. Performance of predictive models was tested using the CIEDE2000 total color difference formula (ΔE00), while accuracy was evaluated by comparative assessment of ΔE00 with corresponding 50:50% acceptability (AT00) and perceptibly (PT00) thresholds for dentistry. A mean color difference between measured (real) and predicted color of ΔE00=1.71, with 62.86% of the color differences below AT00 and 28.57% below PT00, was registered for monolithic samples. For bi-layered samples, the mean color difference was roughly ΔE00=0.50, with generally 100% and more than 85% of the estimations below AT00 and PT00, respectively. The predictive method allowed highly accurate color estimations for both monolithic and layered dental resin-based composites with varying thicknesses and under different illuminations. These results could be useful to maximize the clinical success of dental restorations.

Effects of different toothpastes on the color and whiteness of stained anterior composite resin

PURPOSE

To evaluate changes in the color of an anterior nanohybrid composite resin and differences in its whitening index after 30 days of brushing with six brands of whitening toothpaste in vitro to simulate the situation in individuals with high coffee consumption.

METHODS

Eighty-four disk-shaped resin specimens were prepared (shade A2). For initial staining, the samples were immersed in coffee solution for 14 days and then divided into eight groups for treatment with various toothpastes. Color was assessed at the baseline, after initial staining, and on days 7, 14, and 30 of the staining-and-brushing cycle. Color stability was evaluated based on the CIEDE2000 color difference (ΔE00), and differences in whiteness were determined using the whitening index for dentistry (WID).

RESULTS

The highest ΔE00 and ΔWID values were obtained with Colgate Herbal, followed by Opalescence Whitening and Crest Baking Soda and Peroxide, whereas the lowest values were obtained with distilled water, followed by Yotuel Pharma B5, on day 30 of the staining-and-brushing cycle.

CONCLUSION

In terms of improving the color and whiteness of coffee-stained anterior nanohybrid composite resin, Colgate Herbal, Opalescence Whitening, and Crest Baking Soda and Peroxide yielded promising results after 30 days of continuous use.

The impact of remineralization agents on dental bleaching efficacy and mineral loss in bleached enamel

This study evaluated the effect of remineralization agents on bleaching efficiency, enamel mineral changes, and post-bleaching color stability. A total of 112 enamel-dentin blocks were prepared from bovine teeth. Following initial color measurements, separate treatment regimens were carried out as follows: negative control (no treatment); positive control (bleaching only); bleaching, then NaF; bleaching + NaF (mix); bleaching, then CPP-ACPF; bleaching + CPP-ACPF (mix); bleaching, then nHAP+F; bleaching + nHAP+F (mix). Color measurements were repeated after immersion in distilled water for 7 days, and again after staining with coffee solution for 14 days. The CIELAB-based whiteness index was used to evaluate bleaching efficiency, and the CIEDE2000 color difference formula for color stability. Chemical investigation was performed using scanning electron microscopy with energy dispersive spectroscopy and X-ray diffraction analyses. The experimental groups showed significant increases in whiteness compared to the negative control, and the staining after bleaching did not result in statistically significant differences between the groups. Energy dispersive spectroscopic analysis revealed that bleaching protocols had no impact on elemental levels as well as the ratio of Ca/P. The combined use of bleaching agents with remineralization agents did not affect bleaching effectiveness but also did not provide an additional contribution.

Effectiveness of violet LED dental bleaching compared to 35% hydrogen peroxide: An in vitro study

AIM

This in vitro study assessed the efficacy and adverse effects of violet LED bleaching with or without bleaching agents.

MATERIAL AND METHODS

Dental blocks (n=40) were randomly distributed in 4 groups: violet LED (VL), 35% hydrogen peroxide (HP35), the association of hydrogen peroxide 35% with violet LED (VHP35) and the association of hydrogen peroxide 35% with blue LED (BHP35). Specimens were analyzed for Vickers microhardness initially, immediately after and seven days after ending bleaching protocol. The color analysis of the specimens was evaluated for bleaching effectiveness (ΔE2000, ΔE1976) and whiteness index (ΔWID) with EasyShade spectrophotometer, before bleaching protocol and seven days after ending bleaching protocol. The mineral composition of the enamel was evaluated by percentage of phosphorus and calcium on the enamel surface with energy dispersive spectroscopy (EDS). The color and the microhardness data were analyzed using one-way ANOVA with post-hoc Tukey (α=0.05).

RESULTS

The microhardness test showed a difference among the groups only immediately after the completion of the protocol, in which there was a reduction in the value for the groups HP35 from 277,36 ± 21,56 to 198,76 ±32,2 (p<0,01); and BHP35 from 261,14 ± 36,01 to 212,66 ± 25,99 (p<0,01), but the microhardness was reestablished after seven days. Regarding EDS analysis, a reduction in the mineral percentage immediately after bleaching with the use of VL was observed, however, after seven days it was reestablished. Regarding the color analysis, there was no difference among the groups evaluated.

CONCLUSIONS

The use of VL was effective as a dental bleaching tool and did not adversely affect the enamel surface after seven days of the ending of the bleaching protocol.

The effect of amine-free initiator system and polymerization type on long-term color stability of resin cements: an in-vitro study

BACKGROUND

This in vitro study evaluated the effect of amine-free initiator system and polymerization type on long-term color change of amine-free light-cure and dual-cure resin cements.

METHODS

Sixty disk-shaped specimens (10 × 1 mm) were prepared from six different amine-free resin cements; NX3 Nexus light-cure (LC) and dual-cure (DC), Variolink Veneer (LC) and Variolink II (DC), Relyx Veneer (LC) and Rely X Ultimate (DC). A feldspathic porcelain specimen (12 × 14 × 0.8 mm) was obtained from a CAD/CAM block (Cerec Blocks; Sirona Dental Systems GmbH, Bensheim, Germany) for color testing. The feldspathic specimen was placed on the resin cement disk and all measurements were performed without cementation. A spectrophotometer was used for color measurements. Specimens were subjected to thermal aging (5 °C and 55 °C; 5000 and 20,000 cycles). Specific color coordinate differences (ΔL, Δa, and Δb) and the total color differences (ΔE₀₀) were calculated after immersion in distilled water for different periods. Normality of data distribution was tested by using the Kolmogorov-Smirnov test. Data were statistically in a model of repeated measures, using multivariate tests and Tukey's multiple comparison tests at a significance level of p < 0.05.

RESULTS

∆E₀₀ values of resin cements were influenced by cycle periods, significantly (p < 0.05). The highest ΔE00 values for long term were obtained in the NX3 (DC) (3.49 ± 0.87) and the lowest in the NX3 (LC) (1.41 ± 0.81). NX3 (LC), Variolink (DC), RELY X (LC) resin cements showed clinically acceptable color change after long-term aging (∆E₀₀ < 1.8).

CONCLUSION

Light-cure resin cements should be preferred for long-term color stability of full ceramic restorations.

Effects of At-Home and In-Office Bleaching Agents on the Color Recovery of Esthetic CAD-CAM Restorations after Red Wine Immersion

The aim of this study was to evaluate the effects of at-home and in-office bleaching agents on esthetic CAD-CAM materials after red wine immersion by measuring their optical properties. Sixty specimens were prepared out of three esthetic CAD-CAM materials: Vita Enamic, Celtra Duo, and Ceresmart (n = 20). All specimens were immersed in a red wine solution, and color measurements were performed. Specimens were randomly divided (n = 10) according to the bleaching procedure (in office, at home), bleaching durations were set to 3 time points, and color measurements were performed. According to the Commission Internationale de l’Eclairage (CIE) L* a* b* parameters, CIEDE2000 color differences (ΔE00), translucency parameters (TP00), and whiteness index values (ΔWID) after wine staining and after bleaching were calculated. Data were analyzed using the Mann−Whitney U-test, the Kruskal−Wallis test, and a two-way analysis of variance (ANOVA) (α = 0.05). ΔE00, ΔTP00, and ΔWID decreased with an increase in bleaching treatment. ΔE00 after the final bleaching treatment of in-office bleaching ranged from 1.7 to 2.0, whereas those of in-office treatment ranged from 0.4 to 1.1. All ΔTP00 and ΔWID after the final treatment were below the 50:50% perceptibility thresholds (ΔTP00 < 0.6, and ΔWID < 0.7). Significant differences in ΔE00, ΔTP00, and ΔWID among esthetic CAD-CAM materials were found between CD and CE. In the present study, color recovery after at-home and in-office bleaching appeared to be material-dependent. In-office bleaching showed more effective recovery comparing to at-home bleaching.

The effect of bleaching applications on stained bulk-fill resin composites

Background

The structure of bulk-fill resin composites differs from that of their conventional counterparts, but how this difference affects the color stability of the former after staining and bleaching is unclear. Accordingly, this study was aimed at investigating color change in nine bulk-fill resin composites and one nanohybrid resin composite treated with hydrogen peroxide and carbamide peroxide after staining with tea, coffee, and red wine.

Methods

Eighty specimens were prepared from each resins [Clearfil Majesty Posterior (CMP), SDR flow⁺ (SDR), Filtek^TMBulk-Fill Flowable Restorative (FBF), Reveal HD Bulk (RHD), Beautifil-Bulk Restorative (BBR), Tetric EvoCeram® Bulk Fill (TEC), SonicFill™2 (SF2), everX Posterior™ (eXP), X-tra base (XB), and Venus® Bulk Fill (VBF)]. Following baseline color measurements, the specimens were randomly divided into 4 groups according to immersion solutions and distilled water as the control. At the end of a 30-day test period, color measurements were repeated, and color change values (∆E₀₀) were calculated. Each resin group was then divided into 2 subgroups (with 10 specimens per group) on the basis of bleaching agent (Opalescence Boost 40%, Opalescence PF 16%). Following bleaching application, ∆E₀₀ and changes of whiteness (∆WI_D1 = WI_Dbleaching-WI_Dbaseline, ΔWI_D2 = WI_Dbleaching-WI_Dstaining) values were recorded. Two- and three-way analyses of variance and Tukey’s post hoc test were performed, with a P < 0.05 regarded as indicative of significance.

Results

After immersion in distilled water, tea, and red wine, the highest ΔE₀₀ values were observed in eXP (P < 0.05). Resin materials immersed in coffee and tea exhibited statistically higher ∆E₀₀ values than those immersed in red wine except for eXP, TEC, and FBF (P < 0.05). For eXP, the highest ∆E₀₀ values were recorded in distilled water. For TEC and FBF, there was no statistically significant difference among the immersion solutions and distilled water (P > 0.05). For all the resins and staining beverages, no statistically significant difference in ∆WI_D1 and ∆WI_D2 values were detected between bleaching agents (P > 0.05). All the ΔWI_D1 values were above the whiteness perceptibility threshold.

Conclusion

The bulk-fill materials were more resistant to discoloration and bleaching procedures than the conventional resin composites. Coffee and tea caused more staining than distilled water and red wine generally. The type of bleaching procedure had no effect on the whiteness of the tested materials.

Visual and instrumental coverage error of two dental shade guides: an in vivo study

OBJECTIVES

This study aims to evaluate in vivo the color agreement between natural teeth and dental shade guides by means of visual and instrumental coverage error ([Formula: see text]) index.

MATERIALS AND METHODS

The color of the middle third of 735 incisors was visually determined by two evaluators using the Vita Classical (VC) and Vita 3D Master (V3DM) shade guides. The color match between the natural tooth and the shade tab was rated as poor (P), good (G), or optimum (O) by each observer. CIE color coordinates of the target teeth and shade tabs of VC and V3DM were instrumentally measured using a clinical spectrophotometer. Visual ([Formula: see text]) and instrumental ([Formula: see text]) coverage error indexes were computed using CIELAB and CIEDE2000 metrics for both shade guides. For [Formula: see text] calculation, only the concordant inter-observer determination on tooth shade rated as O-O or O-G was used. The results were evaluated using perceptibility (PT, [Formula: see text]= 1.2, [Formula: see text]= 0.8) and acceptability (AT, [Formula: see text]= 2.7, [Formula: see text]= 1.8) color thresholds for dentistry.

RESULTS

VC and V3DM exhibited [Formula: see text] (2.5, 3.2, and 3.2, 2.7 CIELAB units; 1.9, 2.3, and 2.8, 2.4 CIEDE2000 units, respectively, for O-O and O-G match) and [Formula: see text] (4.7, 4.8, and 4.1, 4.6 CIELAB units; 3.3, 3.4, and 3.4, 3.6 CIEDE2000 units, respectively, for O-O and O-G match) values greater than 50:50% AT for both color difference formulas. [Formula: see text] contributes more than 50% (53.2-82.4% range) to the [Formula: see text] value. This contribution depends on the shade guide used and the quality of the visual rating.

CONCLUSIONS

The evaluated shade guides exhibited visual coverage errors above acceptability thresholds, largely due to the contribution of the instrumental coverage error to the visual coverage error.

CLINICAL RELEVANCE

It necessary to further improve commercially available dental shade guides to facilitate achievement of satisfactory esthetics results in clinical practice.

Color and optical properties of 3D printing restorative polymer‐based materials: A scoping review

Objective

Color and optical properties are particularly crucial to mimic natural tooth. This scoping review aimed to present an overview of the literature published on color and optical properties of 3D printing restorative polymer‐based materials. The literature search was performed in MED‐LINE/Pubmed, Scopus and Web of Science.

Materials and methods

The literature search was conducted in the three databases based on the question: “Are the optical properties and color adequately reported on polymer‐based 3D printing dental restorative materials studies?” with no restriction on year of publication. Data were reported and synthesized following PRISMA‐ScR statement.

Results

Nine studies fit the inclusion criteria. Five studies focused on evaluating only color stability; three articles assessed the color stability along with mechanical and morphological properties and only one study compared color parameters of 3D printed to conventional polymers. Two studies evaluated translucency parameter and no study was found evaluating scattering, absorption, and transmittance.

Conclusions

Color and optical properties of 3D printed polymers that can be used in restorative dentistry are not adequately evaluated and characterized. Future studies on the influence of experimental printing conditions should include these physical properties to assist on improving esthetics.

Clinical significance

This review shows the scarce literature existing on color and optical properties of 3D printing restorative polymer‐based materials. These properties and their study are of outmost importance to create materials that mimic natural tooth to allow clinicians to obtain esthetically pleasant restorations.

A Titanium Tetrafluoride Experimental Gel Combined with Highly Concentrated Hydrogen Peroxide as an Alternative Bleaching Agent: An In Vitro Study

This in vitro study evaluated color change, mineral content, and morphology of enamel, pH and cytotoxicity of experimental bleaching agents containing 35% hydrogen peroxide (HP), titanium tetrafluoride (TiF4), Natrosol, and Chemygel. Sixty enamel/dentin blocks were randomly treated with (n = 10) HP; HP+Natrosol+Chemygel with different TiF4 concentrations: 0.05 g HPT0.5, 0.1 g HPT1, 0.2 g HPT2, 0.3 g HPT3, 0.4 g HPT4. Bleaching was performed in three sessions (3 × 15 min application). Color change (CIELab-ΔEab, CIEDE2000-ΔE00, ΔWID) and Knoop microhardness (KHN) were evaluated. Enamel morphology and composition were observed under scanning electron microscopy and energy-dispersive spectrometry (EDS), respectively. Cell viability of keratinocyte cells was evaluated using MTT assay. Data were analyzed by one-way ANOVA and LSD and Tukey tests, and two-way repeated measures ANOVA and Bonferroni (α = 5%). The pH and EDS were analyzed descriptively. Lightness-L* increased, and a* and b* parameters decreased, except for HPT3 and HPT4 (b*). HPT0.5, HPT1, and HPT2 exhibited ΔEab and ΔWID similar to HP. ΔE00 did not present statistical difference. HP, HPT0.5, and HPT1 promoted higher KHN. HPT0.5 exhibited no changes on enamel surface. Keratinocyte cells were viable when treated with T0.5, and weak viable for T1. Experimental agents exhibited acidic pH and Ti elements. HPT0.5 exhibited bleaching efficacy, maintained KHN without enamel alterations, and did not increase cytotoxicity.

Adhesion and whitening efficacy of P11-4 self-assembling peptide and HAP suspension after using NaOCl as a pre-treatment agent

Background

This study evaluated the adhesion and whitening efficacy of a mixture of hydroxyapatite and P11-4 self-assembling peptide (HAP-peptide) on bovine enamel after pre-treatment with low-concentrated sodium hypochlorite (NaOCl).

Methods

Fifty-two caries-free bovine incisors were selected. 50 teeth were randomly allocated to five groups (n = 10). The first group was treated with a mixture of 6.25 wt% HAP and 5 ml P11-4 peptide, using NaOCl 3% as pre-treatment. Second, third and fourth groups were treated with 6.25 wt% HAP, 5 ml P11-4 peptide, and NaOCl 3%, respectively. In the fifth group, only water was applied (control group). The color of samples was measured using a spectrophotometer (USB4000-VIS-NIR-ES, Ostfildern, Germany). To evaluate color changes, ΔE values were statistically analyzed. Finally, adherence of HAP particles on two enamel surfaces with and without pre-treatment with NaOCl was analyzed with SEM.

Results

It was observed that the ΔE of the HAP-peptide suspension after pre-treatment with NaOCl was significantly stronger than the control group. In contrast, the overall color changes of separate applications of HAP, peptide, and NaOCl did not differ notably from the control group. SEM observations confirmed that pre-treatment with NaOCl resulted in a more pronounced coverage of HAP on the enamel surface.

Conclusions

Pre-treatment with a low-concentrated NaOCl enhanced the adherence of the HAP layer on the enamel surface, resulting in a stronger whitening effect.

Trial registration

The peptide-HAP suspension is effective in improving tooth whiteness.

Color Change of Resin-based Composites After In Vitro Bleaching Protocols: A Systematic Review and Meta-analysis

OBJECTIVES

To systematically review the literature on color stability of resin-based composites (RBC) after in vitro bleaching protocols and to assess the influence of bleaching protocols by meta-regression analysis on RBC color stability, and the association with clinical and experimental characteristics.

METHODS

The electronic search was conducted in MEDLINE/PubMed, Scopus, and Web of Science databases and included English language studies that evaluated and reported color differences (CIELAB values) of RBC after in vitro bleaching procedures using hydrogen peroxide and/or carbamide peroxide.

RESULTS

Database search for color change of RBC after bleaching retrieved 1335 eligible papers after removing duplicates. After initial screening, 66 articles were assessed for full-text reading with final inclusion of 23 published papers. A meta-regression analysis showed that storage time (p≤0.01), color measuring device (p≤0.01), and background color (p≤0.01) had influenced on color changes of RBC. The bleaching protocol (bleaching agent and time of application) did not influence on color changes of RBC (p>0.01).

CONCLUSIONS

There is evidence that RBC change color after bleaching, but the change is not clinically significant.

LED/laser photoactivation enhances the whitening efficacy of low concentration hydrogen peroxide without microstructural enamel changes

BACKGROUND

The association of low concentration hydrogen peroxide (HP) and a light source has been widely used to achieve efficient bleaching. We investigated the colorimetric and microstructural changes of bovine enamel bleached with 6% HP associated or not with a hybrid light source system of violet light and laser (LED/laser).

METHODS

Twenty bovine crowns were used to obtain specimens of 7 × 7 × 2 mm. Then, they were randomized in two groups (n=10): 6% HP and 6% HP + LED/laser. After staining with dark tea solution, three bleaching sessions were performed. Colorimetric evaluation (∆L*, ∆a*, ∆b*, ∆E₀₀ [CIEDE2000] and WI_D) after 24 hours of each session and 7 days after the final bleaching session was performed. Enamel Vickers microhardness at baseline, 24 hours and 7 days after the last bleaching session were also evaluated. Two-way repeated measures ANOVA and Bonferroni post-test was used at a significance level of 5%.

RESULTS

6% HP and 6% + HP LED/laser showed satisfactory bleaching results. The group photoactivated showed higher WI_D values (p<0.05). Differences between groups were observed for ∆E₀₀, ∆L* and ∆a* (p<0.05), except for ∆b* (p>0.05). Intra-group differences were also found (p<0.05). Regarding microhardness, no inter or intra-group differences were observed (p>0.05).

CONCLUSIONS

The photoactivation with LED/laser enhanced the whitening efficacy of 6% HP compared to the group without photoactivation. Thus, the LED/laser activation appears to be a good option when using low concentration HP-based agents. In addition, both bleaching protocols did not cause changes on enamel microhardness.

Color Stability and Staining Susceptibility of Direct Resin-Based Composites after Light-Activated In-Office Bleaching

This study evaluated color stability and staining susceptibility of five direct resin-based composites (RBCs) subjected to light-activated in-office bleaching with 40% hydrogen peroxide (HP). The test materials included 5 RBCs, which consisted of one nano-filled, one sub-micron, one bulk-filled, and two nano-hybrid RBC types. Ten disc-shaped specimens of each RBC were fabricated and divided into bleaching (BLE) and non-bleaching (CON) groups (n = 5 for each group). Specimens were then immersed in red wine solution over 4 h. A spectrophotometer was used to obtain Commission Internationale de l'Eclairage (CIE) L*a*b* parameters for each of the following periods tested: before bleaching (T_BA), after bleaching (T_BL), and after staining (T_ST). Color stability and staining susceptibility were evaluated using two metrics, CIEDE2000 color differences (ΔE₀₀) and whiteness variations using the whiteness index (ΔWI_D). Data were analyzed using repeated measures two-way analysis of variance (ANOVA) (α = 0.05). Statistically significant and clinically unaccepted ΔE₀₀ and ΔWI_D were observed for all tested specimens between T_BA and T_BL. The nano-hybrid type RBCs showed the highest discoloration among materials after bleaching treatment. The BLE group exhibited significantly higher ΔE₀₀ and ΔWI_D than the CON group for all the tested RBCs between T_BA and T_ST. The sub-micron type RBC showed the highest discoloration among materials after immersion in the red wine. Conclusion. The light-activated in-office bleaching with 40% HP's influences on color and whiteness index were material-dependent. The use of bleaching treatment also increased the susceptibility to red wine for all RBCs.

In-office tooth bleaching with chitosan-enriched hydrogen peroxide gels: in vitro results

OBJECTIVE

This study aimed to evaluate the effects of adding chitosan to 35% hydrogen peroxide gels (for in-office bleaching), with or without calcium gluconate, on tooth properties and bleaching efficacy.

METHODS

Bovine enamel/dentin specimens (4 × 4 × 2.5 mm) were randomly allocated into groups (n = 10): negative control (unbleached), bleaching with 35% hydrogen peroxide gel (35% HP, commercial gel); 35% HP with 2% chitosan (% wt) (35% HP + chitosan), 35% HP and calcium (35% HP + Ca, commercial gel), and 35% HP + Ca + 2% chitosan. Variation of surface profile (ΔRa) and color analyses (ΔL*, Δa*, Δb*, ΔE*_ab, ΔE₀₀, and ΔWID) were performed comparing specimens at baseline (initial) and 24 h after of storage in artificial saliva (final). Surface microhardness (KHN) values and scanning electron microscopy (SEM) images were obtained on conclusion. The data were analyzed by ANOVA and Tukey's tests (KHN), generalized linear models (ΔL*, ΔE_ab, ΔE₀₀, ΔWID, ΔRa), and Kruskal-Wallis and Dunn tests (Δa*, Δb*) (α = 0.05).

RESULTS

Considering ΔL*, Δa*, Δb*, ΔE*_ab, ΔE₀₀, and ΔWID values, the bleached groups differed from negative control. For ΔRa, chitosan-based groups showed lower variation in surface roughness compared to 35% HP, without significant difference from negative control. For KHN, chitosan groups did not differ from negative control (unbleached control = chitosan groups > 35% HP + Ca > 35% HP). For SEM, slight surface changes were observed in all bleached groups, but the intensity varied according to gel used (35% HP > gels with Ca > gels with chitosan).

CONCLUSION

Chitosan-enriched hydrogen peroxide gels can reduce negative impacts on tooth properties without affecting bleaching efficacy.

CLINICAL RELEVANCE

Although commercial gels containing remineralizing agents such as calcium reduce the negative effects on the properties of teeth, the addition of chitosan appears to be a promising approach to preservation of dental properties without interfering in bleaching efficacy.

Assessment of a novel bleaching agent formula containing 35% hydrogen peroxide and titanium tetrafluoride: an in vitro study

This study developed experimental gels containing titanium tetrafluoride (TiF4) combined with commercial 35% hydrogen peroxide (HP), and evaluated bleaching efficacy and pH of the gels, and mineral content and morphology of enamel submitted to these treatments. In phase-1, different stock gels mixed with TiF4 were combined with HP. In phase-2, the selected gels were tested on enamel/dentin specimens (n=8): HP; HP and Natrosol+TiF4 (HPnT); HP and Natrosol+Chemygel+TiF4 (HPncT); HP and Aristoflex+TiF4 (HPaT). Bleaching was performed in four sessions (3x15min-application/session). Color (CIEL*a*b*) and whiteness index (WID) were measured after each session, whereas whiteness index differences (ΔWID), color alteration (CIELab-ΔE, CIEDE2000-ΔE00), enamel morphology and pH, at end of bleaching therapy. The change in Knoop microhardness (ΔKHN) was compared before and after bleaching. Data were analyzed by two-way repeated measures ANOVA and Bonferroni (CIEL*, a*, b*), one-way ANOVA and Tukey (ΔWID, ΔE, ΔE00), and LSD (ΔKHN) tests (α=5%). SEM and pH measurements were submitted to descriptive analysis. No differences were observed in lightness (L*) or WID among the groups (p > 0.05), but HP exhibited lower b* values (p<0.05), higher ΔWID than HPnT, and the highest ΔE among the groups (p < 0.05). No differences in ΔE00 were observed between HP and HPncT (p > 0.05), and HPncT showed higher ΔKHN than HP (p < 0.05). HP presented pH values closer to neutral (6.9), whereas experimental agents showed acidic pH values (2.3-3.9). No morphological changes were observed in HP or HPncT groups. HPncT was able to bleach the enamel and maintain enamel microhardness and surface integrity, even at low pH.

Influence of background color on color perception in dentistry

OBJECTIVE

To evaluate the influence of neutral color backgrounds on the perception of color differences in dentistry.

METHODS

A software was developed for this study that calculated the perceptibility (PT) and acceptability (AT) thresholds of color differences between a pair of computer-simulated incisor samples (n = 60 pairs) over three neutral color (white, gray and black) backgrounds. CIELAB and CIEDE2000 color difference formulas were used. Five groups of volunteer observers (N = 100) participated in the psychophysical experiment (n = 20): Dentists; Dental students; Dental auxiliaries; Dental technicians; and Laypersons. The psychophysical experiment was performed in a dark environment on a calibrated high-resolution screen. To determine PT and AT values, the 60 pairs of samples were randomly presented to each observer over the different backgrounds. The data were adjusted (TSK Fuzzy) and analyzed statistically using Student t-test and ANOVA (α = 0.05).

RESULTS

Regardless of the metric and the background used, the PT values showed no difference among different observers (p > 0.05). Dentists showed the lowest PT values. Dental technicians showed the lowest AT (p ≤ 0.05) and similar values for the three backgrounds (p > 0.05), regardless of the metric used. The other groups of observers showed the lowest and the highest AT values when using black and white backgrounds, respectively (p ≤ 0.05).

CONCLUSIONS

The lowest AT values using a black background indicates that the use of this background allows for the evaluation of slight color differences, and should be used for challenging color differences in esthetic dentistry. This study showed the influence of the observer experience on color evaluation in dentistry.

CLINICAL SIGNIFICANCE

There was no influence of the background color on the perceptibility threshold. However, dentists and dental technicians showed greater ability to perceive slight color differences compared to other groups of observers.

Impact of short-term dental dehydration on in-vivo dental color and whiteness

OBJECTIVE

To determine in-vivo chromatic and whiteness changes produced by short-term dental dehydration.

METHODS

Spectral reflectance of 452 upper incisors (226 centrals and 226 laterals) of 113 participants were measured using a spectroradiometer at baseline and after short-term dehydration (minutes 2, 4, 6, 8 and 10). CIE L*a*b* color coordinates (L*, a*, b*, C*_ab and h_ab) and whiteness index for dentistry (WI_D) were calculated. Color differences (ΔE₀₀, ΔE_ab^*) and whiteness differences (ΔWI_D) were computed and interpreted based on their respective 50:50% perceptibility (PT) and acceptability thresholds (AT). Statistical analysis was performed using the related samples Wilcoxon signed-rank test.

RESULTS

L* showed an increasing trend with dehydration, while a*, b*, C*_ab and h_ab have a decreasing tendency. All chromatic coordinates showed statistically significant differences (p < 0.003) at each interval of dehydration compared with baseline, except a* for all teeth. For ΔE₀₀ and ΔE_ab^* values were higher than PT after 2 min of teeth dehydration and higher than AT after 6 and 8 min, respectively. The percentage of teeth exceeding corresponding PT was higher than 50% after 2 min. WI_D index increased with dehydration time, while whiteness differences were clinically perceptible after 4 min. Statistically significant differences were found for WI_D between all dehydration intervals (except 8-10 min). The percentage of teeth exceeding whiteness PT was higher than 50% after 6 min of teeth dehydration.

CONCLUSIONS

Short-term dental dehydration produces clinically unacceptable changes in tooth color and clinically perceptible increase in tooth whiteness level.

CLINICAL SIGNIFICANCE

Clinical shade matching must be done within the first two minutes of any clinical procedure that requires precise chromatic determination but implies a risk of tooth dehydration.

Effects of Artificial Staining and Bleaching Protocols on the Surface Roughness, Color, and Whiteness Changes of an Aged Nanofilled Composite

This study evaluated the surface roughness and color alteration of an aged nanofilled composite exposed to different staining solutions and bleaching agents. Ninety nanofilled composite (Filtek Z350XT, 3M/Oral Care) specimens were submitted to 5,000 thermal cycles and immersed in (n = 30): red wine, coffee, and artificial saliva at 37°C for 48 h. Groups were subdivided according to the bleaching protocol (n = 10) with 20% carbamide peroxide, 38% hydrogen peroxide, or without bleaching - control. Mean surface roughness values (Ra - μm) and color parameters (L*, a*, b*) were measured at baseline (T0), after thermal cycling aging and staining (TS), and after bleaching (TB). Color (ΔE00) and whiteness index (ΔWID) changes were determined after aging and staining (Ts-T0) and after bleaching (TB-TS). The adopted perceptibility and acceptability thresholds of the nanofilled composite were 0.81 and 1.71 ΔE00 units and 0.61 and 2.90 ΔWID units, respectively. Ra was analyzed using mixed models for repeated measurements and L* by the Tukey-Kramer test. The a* and b* values were evaluated by generalized linear models for repeated measures. ΔE00 was tested using two-way ANOVA and Tukey tests, and ΔWID by Kruskal-Wallis and Dunn tests (α = 5%). Ra of all groups decreased after aging and staining (TS, p &lt; 0.05), but increased after bleaching only for groups stained with red wine (TB). Aging and staining decreased the luminosity of the composites, but L* increased after bleaching (p &lt; 0.05). Aging and staining increased a* and b* values, but after bleaching, b* values decreased (p &lt; 0.05). After bleaching, ΔE00 and ΔWID were greater in stained groups at both time intervals, regardless of the bleaching protocol. Stained resin composites exhibited perceptible but unacceptable color (ΔE00 &gt; 1.71) and whiteness (ΔWID &gt; 2.90) changes, regardless of the bleaching treatment performed. Therefore, red wine affected the surface roughness of the aged nanofilled resin submitted to bleaching. Bleaching was unable to reverse the color changes promoted by red wine and coffee on the aged nanofilled composite.

Color, lightness, chroma, hue, and translucency adjustment potential of resin composites using CIEDE2000 color difference formula

OBJECTIVE

To evaluate color, lightness, chroma, hue, and translucency adjustment potential of resin composites using CIEDE2000 color difference formula.

METHODS

Three resin composites (Filtek Universal, Harmonize, and Omnichroma) were tested. Two types of specimens were prepared: an outer base shade with an inner hole filled with test shades and single-composite specimens of all shades. Spectrorradiometric reflectances measurements and subsequent CIELAB color coordinates and translucency parameter (TP) were performed. Color (CAP₀₀ ), lightness, chroma, hue, and translucency (TAP₀₀ ) adjustment potential using CIEDE2000 color difference were computed. Color and transparency differences among composite materials and shades were statistically tested (P < 0.05).

RESULTS

Positive CAP₀₀ and TAP₀₀ values were found for majority of tested materials. CAP₀₀ values ranged from -0.14 to 0.89, with the highest values found for Omnichroma (>0.75 in all cases). TAP₀₀ values ranged from -0.06 to 0.86 with significant translucency differences among dual and single specimens. Omnichroma exhibited the highest adjustment potential for all color dimensions studied.

CONCLUSIONS

Lightness, hue, chroma, and translucency adjustment potential have been introduced using CIEDE2000 color difference formula, and have shown their usefulness to evaluate blending effect in dentistry. Color coordinates and translucency adjustment potential were dependent on dental material. Omnichroma exhibited the most pronounced blending effect.

CLINICAL SIGNIFICANCE

Resin composites with increased color and translucency adjustment may simplify shade selection, making this process easier and less time consuming. Furthermore, these materials might facilitate challenging and complex color matching situations.

Color inconstancy of natural teeth measured under white light-emitting diode illuminants

OBJECTIVE

To evaluate color and whiteness changes of natural teeth under nine white LED illuminants recently proposed by CIE.

METHODS

From spectral reflectance factors of 36 caries-free upper central incisors, corresponding colors under illuminant D65 and CIE 1931 standard colorimetric observer were computed for all tested illuminants, using the chromatic adaptation transform CAT16. Color differences (CIELAB and CIEDE2000 units) and whiteness (WI_D and WI_O indices) from teeth illuminated by CIE standard illuminants (D65 and A) and white LED illuminants were calculated. The appearance of 630 pairs of teeth under all illuminants was also evaluated.

RESULTS

Color gamuts from 36 teeth under tested illuminants showed similar volume and shape in CIELAB color space, but their centers of gravity changed in many different directions with respect to colors under D65 or A illuminants: Considering colors under D65/A, color shifts produced by white LED illuminants were in the ranges 2.0-8.6/1.1-7.0 CIELAB units (1.4-8.2/0.6-6.8 CIEDE2000 units). Average WI_D and WI_O values for the 36 teeth under different illuminants ranged from -5.8 to +19.3 and from -7.7 to +11.1, respectively. Considering 630 pairs of teeth, average color differences (mainly lightness differences) were below 0.5 CIELAB units (0.3 CIEDE2000 units), and average whiteness differences ranged from 8.1 to 10.7 for WI_D (23.4-25.1 for WI_O).

SIGNIFICANCE

Using CIE LED illuminants, most changes in color and whiteness for individual teeth were above typical threshold values of perceptibility and acceptability in dentistry. However, considering pairs of teeth, the average color and whiteness differences under all tested illuminants were very similar.

Efficacy of whitening toothpaste containing blue covarine: A double-blind controlled randomized clinical trial

OBJECTIVE

This randomized clinical trial evaluated the efficacy and safety of a blue-covarine whitening toothpaste on tooth bleaching.

SUBJECTS AND METHODS

Seventy-five subjects with shade mean C1 or darker were randomized into three groups (n = 25): CT-conventional toothpaste, WT-whitening toothpaste, and CP10-10% carbamide peroxide. Subjects from CT and WT brushed their teeth twice/day for 2 weeks. CP10 used bleaching gel for 4 hours/night for 2 weeks. Tooth shade and CIELab parameters were measured at baseline, after the first application, 2- and 4-week. ΔE*_ab and ΔE₀₀ were calculated. Subjects' perception about tooth color appearance, tooth sensitivity (TS), and gingival irritation (GI) were also assessed.

RESULTS

At all evaluation periods, it was not observed differences between WT and CT considering tooth shade (P > 0.7) or CIELab parameters (P > 0.3). At 2- and 4-week, ΔE*_ab and ΔE₀₀ were higher for CP10 than WT or CT (P = 0.001). WT and CT reported major dissatisfaction with tooth color appearance than CP10 (P = 0.001). At 1- and 2-week, WT experienced GI and TS similar to CT, both lower than CP10 (P < 0.01).

CONCLUSION

There were no significant differences in the whitening efficacy between whitening and conventional toothpastes. Neither of the dentifrices was as effective as at-home bleaching.

CLINICAL SIGNIFICANCE

The silica-based toothpaste containing blue covarine evaluated in this study did not give significant tooth whitening benefits over 2 weeks of use.

Influence of Bleaching and Aging Procedures on Color and Whiteness of Dental Composites

Bleaching can cause perceptible color changes on resin-based composite (RBC) restorations that may not be stable with aging. The objective of this study was to evaluate color stability and whiteness variations of RBCs after bleaching and aging procedures. Discs (10 mm in diameter and 1 mm thick) of shades A2 and A3 were fabricated from two RBCs (Filtek Z250 and Filtek Z350 XT) and divided into three subgroups (for each composite and shade) (n=5) as follows: control (no bleaching), at-home bleaching, and in-office bleaching. All specimens underwent an accelerated artificial aging up to 450 KJ/m2 and 900 KJ/m2 in an aging chamber (Suntest XXL+). A spectroradiometer (SpectraScan PR-670) was used to obtain CIE L*a*b* coordinates. CIEDE2000 color difference (ΔE00) and whiteness index for dentistry (WID) were used to evaluate color stability. Color and whiteness differences data were analyzed considering the 50:50% visual color difference thresholds (perceptibility [PT] and acceptability [AT]) and 50:50% whiteness thresholds (whiteness perceptibility [WPT] and whiteness acceptability [WAT]). Analysis of variance and Tukey tests (α=0.05) were used to statistically analyze the data. After bleaching, all specimens showed ΔE00 and ΔWID values below their corresponding acceptability thresholds (AT and WAT, respectively). After aging, L* and WID values decreased while b* values increased (p≤0.05), resulting in ΔE00 and ΔWID values above AT and WAT, respectively. Color changes after bleaching RBCs were clinically acceptable, while aging provoked clinically perceptible color changes.

Whiteness difference thresholds in dentistry

OBJECTIVE

To determine the visual whiteness thresholds for esthetic dentistry using the whiteness index for dentistry based on CIELAB color space (WI_D).

METHODS

A total of 60 observers (Dentists and Laypersons; n=30) from three research sites participated in the study. A psychophysical experiment based on visual assessments of simulated images of teeth on a calibrated display was performed. Images of simulated upper central incisors (SUCI) were consecutively displayed in pairs (60) and the whiteness of each SUCI pair was compared. WI_D was used to calculate the visual thresholds (WPT- perceptibility threshold; and WAT- acceptability threshold) with 95% confidence intervals (CI) and a Takagi-Sugeno-Kang (TSK) Fuzzy Approximation model was used as fitting procedure. Data was statistical analyzed using paired t-test (α=0.05).

RESULTS

WPT and WAT were 0.72 (CI: 0.0-2.69; r²=0.52) and 2.62 (CI: 0.2-7+; r²=0.57) WI_D units, respectively. Significant differences (p<0.05) were found between WPT and WAT, and between dentist (WPT=0.46WI_D units; WAT=2.20 WI_D units) and layperson (WPT=0.94 WI_D units; WAT=2.95 WI_D units).

SIGNIFICANCE

The visual whiteness difference thresholds determined with WI_D index can serve as reference values for research and manufacturing of dental materials, and for clinical practice situations such as assessing the effectiveness of bleaching treatments.